A Healthier Society Through Precision Medicine

The Taiwan Precision Medicine Initiative offers the opportunity to dramatically improve the nation’s medical landscape and advance the lucrative biomedical sector with an ambitious DNA mapping project.

“The best doctor cures the illness that is still obscure, the good doctor cures the illness that is about to break out, and the ordinary doctor treats the disease that is fully manifested,” recites Dr. Chen Yuan-tsong. He clearly relishes repeating advice that was first recounted some two millennia ago in the Esoteric Scripture of the Yellow Emperor – and which has been a fundamental tenet of Chinese medicine ever since.

With the rapid development of genetics-led medicine and inception of the Taiwan Precision Medicine Initiative (TPMI), which is attempting to profile the genetic makeup of 1 million Taiwanese, a prevention-rather-than-cure approach is more relevant than ever, says Chen.

An Institute of Biomedical Sciences research fellow at Taiwan’s Academia Sinica and a professor of pediatrics at Duke University in the United States, Chen is one of the world’s leading authorities in the emerging field of genomics. His research involves the investigation of our entire genetic makeup and provides information that can help make effective diagnoses and provide customized treatments.

“TPMI offers the opportunity to establish risk models that predict common disease risks, including cancer and early screening or tailored management before the disease is manifested,” relates Chen, who recently received the Presidential Science Prize and an NT$2 million award from President Tsai Ing-wen for his lifelong contribution to science in Taiwan.

Though not directly involved in TPMI, Chen is a big supporter and speaks highly of his colleague at Academia Sinica, Dr. Kwok Pui-yan, a distinguished research fellow and director of the Institute of Biomedical Sciences, who is driving the project forward. Chen views TPMI as offering the opportunity to transform an “ordinary doctor” into a “good doctor and best doctor” on a nationwide basis.

“Not only does the project have immediate and long-term health benefits for Chinese people, but it also has an impact on the local industry in healthcare, semiconductors, precision instruments, computers, and medical AI,” Chen said by email from the U.S.

TPMI is still in its infancy. It was launched at the start of this year to help Academia Sinica and the country’s foremost medical centers reach the goal of profiling the genetic makeup of 1 million citizens.

The study has two main aims. First, markers – a gene or DNA sequence with a known location on a chromosome found in each individual’s genetic profile – are used by researchers to create a predictive model of how medicines will affect the individual, thereby making them more effective and preventing dangerous side-effects. This development has huge ramifications, not just for patients, but for doctors and the pharmaceutical industry as well.

Secondly, the study will aid researchers in identifying genetic risks for diseases in Taiwan by looking at the relationship between individuals’ genetic profiles and the clinical information of the 1 million participants. Identifying genetic factors that increase disease risk will enable physicians to know in advance what disease to look for, reducing the amount of guesswork in diagnosis.

Early screening can thus be carried out for those at high risk of lung, liver, and colon cancer, which are the nation’s deadliest diseases. Doctors will be able to suggest treatment plans not only to cope with the disease, but to prevent the disease from manifesting itself in the first place. Like the best Chinese doctor of yore, medical examiners will be able to suggest lifestyle changes to prolong lives without the need for intervention and expensive drugs.

Great records

Originally from Hong Kong but primarily trained in the U.S. at the University of Chicago and Washington University, Dr. Kwok currently splits his time about evenly between his roles in Taiwan and as professor medicine at the University of California, San Francisco. At Academia Sinica, he oversees research that develops and applies tools for analyzing genetic traits.

Speaking over Skype from the U.S., Kwok said his field of study was fundamentally transformed by the Human Genome Project, an undertaking that mapped the entirety of the human genome, in 2003.

“Now with DNA technology and research there is a path forward to finding all the genes that cause illness and disease,” says Kwok. He says that he wants to integrate genetics into his clinical practice because he currently has to rely on patients’ knowledge of their family’s medical history. “But the way we can analyze DNA now will allow us to be more precise about what we have inherited from our parents and ancestors.”

The ability to obtain such precise information is the main purpose of precision medicine. “We still need to think about the environment and other factors, like pollution and toxins,” Kwok says. “But you really have to start with your biology.”

He characterizes TPMI’s work as building a database, gathering and compiling a lot of information using AI, and optimizing healthcare plans on a targeted and individualized basis. He says this is impossible to do in the U.S. or UK because they are too genetically diverse and “the signal we are trying to look for is confused or confounded.”

“Taiwan is kind of perfect because it is so homogeneous, with about 96% of the population being Han Chinese,” says Kwok. “Also, Taiwan is really strong medically and has a long history of electronic medical records, starting from around 1986.” He notes that e-records are not so commonplace in the U.S.

In addition, Taiwan’s comprehensive national health insurance scheme and strong background in R&D make it the ideal place to conduct a precision medicine study. The target is to collect genetic profiles from at least 4% of the island’s population of 23.8 million – which comes out to just under 1 million. So far, genetic profiles from 100,000 people have been gathered, with the goal of 1 million likely to be reached in 2022.

Getting a DNA sample is far easier and less invasive than other procedures, such as drawing blood. Individuals wishing to join TPMI can contact their local hospital. After their genetic profile becomes part of their medical record, it can be used by physicians to help diagnose and treat illnesses.

Furthermore, the individual’s anonymized electronic medical record and genetic profile will be added to a central research database called the “TPMI Data Lake,” used to help researchers identify disease risk variants for common diseases.

Kwok notes several advantages that TPMI has over other testing methods. For one, at NT$1,200 per procedure (paid by the program), it is cheaper than performing a blood test. It is also more informative and, given the stable nature of the results, it only needs to be performed once. Kwok adds that using TPMI to screen for diseases is much more cost effective than treatment, and that its implementation will mean healthier patients, lower medical costs, and a higher level of biomedical research in Taiwan.

As for funding, Kwok says Academia Sinica is currently meeting the costs, but the amount needed for the next three years it is not yet fully assured, so more government money may be needed further down the line. The projected costs are about US$5 million-$7 million a year.

“The funding has been promised,” says Kwok. “But there is a chance of that not coming through. We are engaging philanthropists and industry just in case.” He notes that crowdfunding might also be considered.

A perfect fit

TPMI and its precision medicine approach would appear to be a good fit for Taiwan and its evolving economy. Biomedicine is considered to be a “priority sector” in the central government’s 5+2 Innovative Industries program, which focuses on upgrading the nation’s traditional manufacturing base and moving up the value chain to have a say in the world’s most lucrative new markets.

Transforming Taiwan into a hub for medical R&D is an enticing prospect because it leverages the country’s excellent healthcare system and deserved reputation for technological prowess. According to the Executive Yuan’s Department of Information Services, the government approved the Biomedical Industry Innovation Program in November 2016 to “bring even greater health and wellness to the people of Taiwan, and establish the nation as a capital of biomedical research and development in the Asia-Pacific region.”

The government’s ambitious aim is to create a trillion NT dollar biomedicine industry by 2025. As of 2018, according to a report from PwC Taiwan, strong government support in terms of financial investment had contributed to bringing the production value of Taiwan’s biomedical industry to NT$514.1 billion (about US$16.6 billion).

According to California-based market intelligence, research, and advisory company BIS Research, the global precision medicine market is expected to grow from an estimated US$78.85 billion in 2018 to about US$216.75 billion by 2028, a healthy compound annual growth rate of 10.64%.

“Growth in the precision medicine market is propelled by an increasing demand for personalized treatment” and technological innovation,  the BIS report states.

The U.S. in 2015 introduced its own Precision Medicine Initiative to develop targeted therapeutics. As a result, the number of companies running biomarker or genetic tests has risen dramatically, especially for chronic disease. Elsewhere, up to 40 countries have introduced their own version of such an initiative, but the ante is being set by China. America’s US$215 million investment is dwarfed by China’s mega precision medicine program, which was launched in 2016 and is said to be funded by the government to the tune of US$9 billion over 15 years.

 Although TPMI was launched to leverage Taiwan’s resources to aid the domestic population, eventual cooperation with China’s initiative is an eventual possibility.  

“It’s a public health need and opportunity,” says Kwok. “If extended to the rest of the 2 billion Chinese around the world, it could be a big market opportunity.”

But at this stage, collaboration with China was considered impractical. For one thing, China lacks good electronic medical records and its medical system is not as advanced, which makes it hard to get quality data. For TPMI, accuracy is paramount.

“Once we have a critical mass of data, it can be extrapolated to China and elsewhere,” Kwok says. Evidence of the health benefits and market opportunities that TPMI brings to the table is apparent from the case of the UK Biobank, he notes. Starting in 2006, the scheme has recruited 500,000 volunteers and has become a powerful tool for scientists to discover why some people develop certain diseases and others do not.

As Kwok makes clear, TPMI offers massive potential public-health benefits as life expectancy increases and societies such as Taiwan’s become super-aged. Diseases such as Alzheimer’s and cancer cannot always be successfully treated, but their onset can be delayed.

Developing precision medicine tools at an early stage makes solid financial sense. It will open up a new era of medicine for researchers so that patients and doctors can pool resources and develop tailored or individual-care plans that optimize health outcomes. “This is the future, so we need to get on with it,” Kwok concludes.   

FAQs

What can precision medicine do for Taiwan?
*Increase the efficacy and safe use of medications
*Facilitate early diagnosis and health promotion
*Provide personalized healthcare

What does the Taiwan Precision Medicine Initiative (TPMI) do?
* Data gathered by TPMI will improve disease risk prediction and help doctors tailor healthcare according to an individual’s genetic profile for disease prevention, early disease screening, most appropriate treatment, and best quality of life.

Does TPMI help people of all ages?
* Precision Medicine is applicable to everyone. Disease preventive measures are most effective when taken before clinical symptoms appear, so even young people who are healthy will benefit from the TPMI.

How can I join TPMI?
Contact the hospital you most frequently visit, go to the TPMI website and complete an application form, or phone (02) 2782 3770.

SOURCE: TAIWAN PRECISION MEDICINE INITIATIVE (TPMI.IBMS.SINICA.EDU.TW)

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